Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Production and Evaluation of Floating Photocatalytic Composite Particles Formed Using Pickering Emulsions and Membrane Emulsification

This document is the Accepted Manuscript version of a Published Work that appeared in final form in Industrial and Engineering Chemistry Research [© American Chemical Society] after peer review and technical editing by the publisher. To access the final edited and published work see: http://dx.doi.org/10.1021/ie3001748Floating photocatalytic composite particles were created by injecting a lipid (sunflower oil or liquefied cocoa butter) into an aqueous suspension of TiO2 nanoparticles using the process of membrane emulsification to control the (Pickering) emulsion size. The composite particle median diameters were controlled in a range from 80 to 300 μm. The composite particles floated in water and possessed photocatalytic activity, which was further enhanced by chemically incorporating silver particles into the TiO2 shell. The cocoa butter-based composite particles proved more robust and were not affected by the UV photocatalytic process. Using a combination of cocoa butter and hexane, for the core of the particles, it was possible to generate composite TiO2 and lipid particles with 36 mg of TiO2 per gram of particle. Optimal dye decolorization was achieved with a particle surface coverage of between 60 and 80%. Complete surface coverage resulted in a reduced reaction rate due possibly to reflection of the UV light

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

In Situ ATR-IR Study on the Photocatalytic Decomposition of Amino Acids over Au/TiO 2 and TiO 2

The photocatalytic degradation of l-asparagine and l-glutamic acid over Au/TiO2 and TiO2 catalysts was investigated in situ by attenuated total reflection infrared (ATR-IR) in combination with modulation excitation spectroscopy. Oxalate was detected on the catalyst surface, which has not been reported before for degradation of amino acids by studies focusing on intermediates in solution. The ATR-IR spectra provide valuable information on the fate of the nitrogen. Ammonium was detected, in agreement with previous studies. Most importantly, strong signals of cyanide were observed, and this assignment has been corroborated by 15N labeling experiments. Cyanide was not reported before, to the best of our knowledge, for the photocatalytic degradation of amino acids. Cyanide was formed in the presence and the absence of gold particles on the TiO2 surface. The cyanide leads to leaching of gold via Au(CN)2− species that were detected in solution by mass spectrometry